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CHANGES IN SKIN COLOURYellow skinDarkening of skinAbsence of colourJaundice likelyIs skin smooth or scaly?Is skin smooth or scaly?Recognise and refer same day thejaundiced patient if:• Pregnant• Temperature ≥ 38ºC• Confusion• Easy bruising or bleeding• Persistent vomiting• Severe abdominal pain• Fingerprick Hb < 10• On any medicationSmoothDark brown patches oncheeks and upper lipScalyScaly dark or light patchesusually occur on the trunk –they may coalesce.SmoothIs absence of colour generalised or patchy?PatchyGeneralisedPresent from birth, hair andeyes are involved.Approach to jaundiced patient whodoes not need same-day referral:• If patient takes > 21 drinks/week(man), > 14 drinks/week (woman)and/or > 5 drinks/session, assess foralcohol abuse 83.• Check ALT and ALP/GGT.• Review with blood results.ALT ≥ 120Do hepatitis Bscreen.ALP/GGT ≥ 3times upper limitRefer forultrasound liverand furthermanagement.• Review weekly.• Repeat fingerprick Hb.• Refer if Hb falls < 10, patientdevelops markers of severity aboveor jaundice persists > 6 weeks.Melasma likely• Avoid use of skin-lighteningagents.• Encourage sun avoidanceand use of sunscreen.• Change oral contraceptiveto alternative contraception91.• Ask about symptoms ofmenopause 98.• Stop all topical preparationslike cosmetics, perfumes,perfumed soap andmoisturisers.• This is often difficult totreat.Tinea versicolor likely• Apply selenium sulphideshampoo to affected areasovernight once a week.• Advise that colour maytake months to return tonormal, but that absenceof scale indicates adequatetreatment.• Recurrence is common.Vitiligo likely• Advise use of camouflagecosmetics.• Skin colour may return butseldom does on hands, feet,lips and genitalia.• Refer to dermatologist ifextensive.Albinism likely• Encourage sun avoidanceand use of sunscreen.• Monitor for thedevelopment of skincancers.Refer if diagnosis is uncertain.47